Stewart Whitney, MD, Philip George, MD, Justin George. Icahn School of Medicine at Mount Sinai
Background: This is a 29 year old female with past medical history of severe Ulcerative Colitis, refractory to medical therapy, who in the past underwent a laparoscopic subtotal colectomy with end ileostomy, subsequently followed by restorative proctocolectomywithileo-anal (“J-Pouch”) creation and diverting loop ileostomy, who presented for closure of the loop ileostomy.
She tolerated the procedure well, and had a routine post-operative course until POD3, when she began having increased pain, fevers, turbid fluid in the Jackson-Pratt drain, and a new leukocytosis. Because of these findings, she was taken to the operating room for re-exploration.
Video will be shown at this point. A leak from the tip of the J-pouch appendage is identified after air leak test, is dissected free, and a small bowel resection is performed to resect the portion that had been leaking. Following this, a repeat air leak test was performed, which was negative.
Conclusion: Suspicion for leak from pouch, even with negative imaging prior to diverting ileostomy closure, should be high in patients with sepsis in the early postoperative period after closure of loop ileostomy after IPAA. The“J-pouch”appendageisafrequentsiteofleak,and if surgical exploration is warranted, can be done laparoscopically
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94876
Program Number: V357
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop
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